Hepatic Encephalopathy, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes Hepatic Encephalopathy, Diagnosis and Treatment and Related DiseasesHepatic encephalopathy happens when the liver is not able to eliminate toxins from the blood causing loss of brain function Early symptoms may be mild and are: 1.Breath with musty odor2.Sleep patterns3.Thought changesDiagnosis:FlappingRaised serum ammoniaTreatment:LactuloseRifaximinLow-protein diet More

This book describes Hepatic Encephalopathy, Diagnosis and Treatment and Related DiseasesHepatic encephalopathy happens when the liver is not able to eliminate toxins from the blood. This is called loss of brain function following the continual liver disease. This disorder may occur suddenly or develop slowly over time.Hepatic encephalopathy, a disorder present in some patients with cirrhosis, may present with personality changes, intellectual impairment, and a reduced level of consciousness. The diversion of portal blood into the systemic circulation seems to be a factor for the syndrome. Hepatic encephalopathy is regarded as a group of neuropsychiatric abnormalities in patients with liver failure, after exclusion of other known brain disease. Hepatic encephalopathy can be subdivided into covert hepatic encephalopathy and overt hepatic encephalopathy.Covert hepatic encephalopathy is a sub-medical, less severe presentation of hepatic encephalopathy and needs psychometric testing for diagnosis.Overt hepatic encephalopathy has an important impact on a patient's quality of life, such as employment and driving ability and is linked with higher admissions to hospital and with deathCausesAn important function of the liver is to convert toxic substances in the body to harmless material. When the liver is injured, these toxins can accumulate in the bloodstream and impair the function of the nervous system.This disorder can happen suddenly and the patient may become ill very quickly. Frequent causes of chronic liver disease in the USA are:1.Chronic hepatitis B or hepatitis C infection2.Alcohol abuse3.Autoimmune hepatitis4.Bile duct disorders4.Some medicines5.Non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)Once the patient has liver damage, episodes of worsening brain function may be triggered by:1.Body is low on water or fluids2.Eating too much protein3.Low potassium or sodium levels4.Bleeding from the intestines, stomach, or esophagus5.Infections6.Kidney disorders7.Low oxygen levels in the body8.Shunt placement or complications9.Surgery10.Narcotic pain or sedative medicinesVarious hypotheses have been proposed to clarify the pathogenesis of hepatic encephalopathy in patients with liver cirrhosis. 1.Changed brain energy 2.Ammonia hypothesis3.GABA hypothesisEarly symptoms may be mild and are: 1.Breath with a musty or sweet odor2.Change in sleep patterns3.Changes in thinking4.Confusion that is mild5.Forgetfulness6.Mental fogginess7.Personality or mood changes8.Poor concentration9.Poor judgment10.Worsening of handwriting or loss of other small hand movements More severe symptoms may be:1.Abnormal movements or shaking of hands or arms2.Agitation, excitement, or seizures (occur rarely)3.Disorientation4.Drowsiness or confusion5.Strange behavior or severe personality changes6.Slurred speech7.Slowed or sluggish movement People with hepatic encephalopathy can become:1.Unconscious,2.Unresponsive, and3.Possibly enter a comaDiagnosisSigns of nervous system changes such as confusion, flapping of handsSigns of liver disease such as jaundice and ascitesAbnormal liver functionArterial ammonia levels are raisedMRI of brain and liverTreatmentAn assessment of the blood ammonia level may be useful in such patients.Precipitants of hepatic encephalopathy should be corrected (e.g., hypovolemia, metabolic disturbances, GI bleeding, infection, constipation).LactuloseAntibiotics such as neomycin and RifaximinProtein restrictionFlumazenil (benzodiazepine antagonist)L-ornithine L-aspartate Sodium benzoate

However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon.

He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com.

His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com.

This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.

From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks.

He apologized for typos and spelling mistakes in his earlier books.

He will endeavor to improve the writing in futures.

Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical conditions.The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com.The medical condition was described simply and direct to the point.Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment.As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date.

He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.

The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks.

He does not do any night duty since 2000 ever since Dr Tan had his second stroke.

His clinic is now relocated to the Bouna Vista Community Centre.

The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.

He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC.

All the PC is upgraded by himself from XT to the present Pentium duo core.

The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.

He is also into DIY changing his own toilet cistern and other electric appliance.

His hunger for knowledge has not abated and he is a lifelong learner.

The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.

This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.